Adult Asthma

Overview

Asthma is a chronic inflammatory disorder of airways, in which your airways narrow and swell and produce extra mucus. This can make breathing difficult and trigger coughing, wheezing and shortness of breath.

The prevalence of asthma was one percent in 1964 in the country. But, new data as per WAO (World Allergy Organization) shows that about 14 per cent people now have asthma .The way these are occurring, WAO believes, that by 2050, about 50 percent of all children will have some sort of allergies.

Since these symptoms could occur due to the other causes also, your doctors would have to confirm the diagnosis

Asthma Trigger

Dust Mite

Pollens from grass, trees ,plants and flowers

Indoor moulds

Smoke

Smell

Viral infection

Exercise

Weather change

Temperature change

Cockroaches

Infection in upper airway, nose, throat

What happens to lung during an asthma attack?

The airway mucosa (inner lining of airway) swells up and secrets thick mucus, which obstructs the airways. The muscles around the airway tighten making the airway narrower. All this makes breathing very difficult.

If the doctor suspects asthma how will he confirm the diagnosis?

Detailed evaluation of symptoms

Physical examination

Routine tests for example x-ray chest, blood test etc

Allergy testing- This test is done to distinguish allergic & non allergic asthma. In allergic asthma it is used to identify the specific allergen & avoidance measures are suggested accordingly.

Pulmonary function testing

The tests determine how much air your lungs can hold, how quickly you can move air in and out of your lungs

The tests can diagnose lung diseases, measure the severity of lung problems, and check to see how well treatment for a lung disease is working.

Lung function tests are done to:

Check the lung function of a person who is regularly exposed to substances such as asbestos that can damage the lungs.

Check the effectiveness of treatment for lung diseases

The testing may take from 5 to 30 minutes, depending upon how many tests are done.

What are the medications used for treatment of asthma and how they work?

Asthma disease has constellation symptoms. The symptoms that are perceived by us are mainly coughing, wheezing, shortness of breath and night awakening, that makes the tip of the iceberg .These symptoms respond well to the short term asthma reliever medications for example bronchodilators.Other symptoms that are constantly present in asthmatic patients are difficulty in breathing out, airway hypersensitivity, excess mucus production and swollen airway. These symptoms do not alarm an asthmatic as they become use to these symptoms. For reduction of underlying airway swelling and these symptoms, it is necessary to use preventer medications regularly.

Asthma treatment consist of two basic classes of medications

Rescuer or reliever medications

Preventer medications

Rescuer medications dilate the tubes of the lungs and are called bronchodilators. They give immediate relief from symptoms but their effect last only for 4 to 6 hours

Preventer medication control asthma attacks and control asthma better. These medications reduces inflammation and widens the air tube that help in reduction of the symptoms

So that preventer medications should be taken regularly till the doctor advice it to be stopped.

What are Inhalers?

The inhalers are devices by which the medications are delivered into the tubes of the lung. With the help of inhaler drug can be delivered directly to the larger surface area of the air tubes resulting in rapid action.

As inhaler devices directly deposit the medicine into the lung tubes, dose of medicine is reduced significantly.

The same medicines in the form of tablets, injections, syrups have side effects where as inhaler does not have any side effect.

What should I do to keep my Asthma under control?

Take the correct amount of medicine.

Avoid coming in contact with allergen.

Avoid asthma triggers.

Avoid emotional stressful situations.

Regular follow up with your physician.

Complications of Asthma

Complication of asthma includes respiratory failure, death and growth retardation in children.

What are the myths and realities of the Asthma?

Myths

Asthma is a contagious disease.

People with asthma cannot work or exercise.

Inhalers are addictive.

Inhales are very strong and they should be used as last resort in asthma.

Steroid inhalers have a lot of side effects.

Realities

Asthma is not a contagious disease.

Asthmatics on regular treatment can work and exercise normally.

Inhalers are not addictive.

Inhalers deliver a small dose of medicines and so that they are the first and safest form of treatment for asthma.

Inhaled steroids are safe even if taken for a prolonged period.

Types of Asthma

1. Unresponsive Asthma

Antiasthma therapy is very effective in treating and controlling asthma symptoms but few patients fail to respond, and continue experiencing troublesome asthma related symptoms even on taking asthma medications on regular basis.

Your physician needs to diagnose and treat the concurrent medical condition for the better control.

2. Complicated Asthma

Although most asthma patients respond well to comprehensive treatment, a few with symptoms and signs of severe asthma supported by objective evidence of obstructive airway disease will have a decidedly inadequate response to treatment.Less than 5% of asthma patients are diagnosed with severe asthma. Among these, some fail to respond to even aggressive asthma management. Such patients are often treated with daily oral corticosteroids, and many become steroid dependent. However, some severe asthma patients have a poor response to even high doses of glucocorticosteroids. Many become steroid-dependent. The term steroid-resistant asthma has been applied to asthma patients who have little or no objective response (improvement in FEV1‚) to even prolonged treatment of high-dose glucocorticosteroids.

It is now clear that the category of severe unresponsive asthma is heterogenous and includes not only steroid-resistant asthma, but also other severe asthmatics that are affected by various co morbidities (e.g., GERD, chronic sinusitis, paradoxical vocal cord dysfunction, bronchopulmonary aspergillosus, psychopathology, uncontrolled triggers {allergens and pollution} immunodeficiency, etc.). These patients may benefit from a consultation at a major academic canter (e.g., National Jewish Health) for a second opinion, always searching for a solution.

3. Brittle asthma

Is a rare form of severe asthma characterized by a wide variation of Peak Expiratory Flow (PEF), in spite of heavy doses of steroids.

Brittle asthma is classified in two types: type 1 characterized by a maintained wide PEF variability (> 40% diurnal variation for > 50% of the time over a period of at least 150 days) despite maximal medical therapy.

Type 2 is characterized by acute attacks occurring within minutes that could lead to death, with a background of well controlled asthma.

Type 1

Type 2

Sex F/M

2.5 F: 1 M

1F:1M

Age yr

15-55

*–

Atopy

Yes

No

Food intolerance

Yes

No

Psychological factors

Yes

No

Morbidity

High

–

Mortality

–

High

4. Allergic asthma

5. Nonallergic asthma

Non allergic asthma is more likely to occur in subjects <4 years or older than 60 years of age. Episodes are triggered by ongoing inflammation, by upper respiratory infection, purulent rhinitis and exacerbation of chronic rhinitis. Most patients have no evidence of IgE antibodies. Indoor air pollution from volatile organic compounds, formaldehyde and wood burning stoves are the trigger factor.

6. Potentially fatal asthma

7. Malignant potentially asthma

8. Aspirin induced asthma

9. Occupational asthma

10. Exercise induced asthma

11. Variant asthma

12. Factitious asthma

13. Vocal Cord Dysfunction and Asthma

14. Coexistent Asthma and Chronic Obstructive Pulmonary Disease

15. Irreversible asthma

Treatment of Asthma

Avoidance therapy

You are advised to avoid the allergens diagnosed by allergy testing by your physician

Disclaimer : The information given in the website is for awareness purpose only. Patients are strictly advised not to self medicate by using the information regarding drugs mentioned in the website www.asthmallergyclinic.in . Self medication is dangerous & can even be fatal in extreme cases. Also due to latest research worldwide in Medical field, the information in the website, may not be updated in real time. Patients are advised to seek advice from an Allergist / Allergy specialist for the correct diagnosis & treatment.